Malterud K
Department of Public Health and Primary Health Care, University of Bergen, Norway.
Scand J Prim Health Care. 1998 Dec;16(4):195-8. doi: 10.1080/028134398750002945.
A substantial proportion of GPs' patients are women who suffer from "unexplained" pain conditions, often from the musculoskeletal system. Few medical findings are revealed, although the symptoms lead to extensive suffering and disability. Two experienced Swedish GPs, Katarina Hamberg and Eva E Johansson, took their own frustration as their point of departure to explore the expectations, experiences, family lives and working lives of women who were sick-listed due to chronic musculoskeletal pain. Their doctoral dissertations, defended at the University of Umeå in September this year, are based on a qualitative interview study with 20 women aged 21-61 years. Johansson and Hamberg found that when seeing a doctor, the women expect to be seen, heard and taken seriously, to get information and time for discussion with the doctor, and to receive help and support over time. However, they experienced being ignored, disregarded and rejected. Symptom perception was characterized by loss of control and feelings of threat and unpredictability. The women believed that the pain had a bodily origin triggered by various mechanisms such as heavy and monotonous work, environmental influences, tensions and worries, rightful punishment or heritage. The Swedish study showed that family considerations had a strong impact on organizations and priorities in paid work. In this sample of working class women, family orientation strengthened and works aspiration declined in a situation of pain and sick leave. Problems related to rehabilitation could be explained by looking more closely on home conditions, especially the unwritten deal among the woman and her partner regarding the division of duties and power structure--the marital contract. Experiences of abuse and violence were reported to Hamberg and Johansson by several women, most of them considering this to be one root of their pain and ill health. The women emphasized that an understanding doctor would ask about violence, apprehend the hints, confirm that it was acceptable to talk about it, and avoid the questioning and blame that easily might increase the woman's feelings of guilt.
很大一部分全科医生的患者是患有“不明原因”疼痛病症的女性，这些病症通常源于肌肉骨骼系统。尽管症状给患者带来了巨大痛苦和残疾，但几乎没有医学检查结果能揭示病因。两位经验丰富的瑞典全科医生，卡塔琳娜·哈姆贝格和伊娃·E·约翰松，以她们自己的挫败感为出发点，去探究那些因慢性肌肉骨骼疼痛而被列入病假名单的女性的期望、经历、家庭生活和工作生活。她们的博士论文于今年9月在于默奥大学进行答辩，该论文基于对20名年龄在21至61岁之间的女性进行的定性访谈研究。约翰松和哈姆贝格发现，这些女性在看医生时，期望能被接待、被倾听并得到重视，期望能获取信息并有时间与医生讨论，期望能在一段时间内得到帮助和支持。然而，她们却经历了被忽视、被漠视和被拒绝。症状感知的特点是失去控制以及感到威胁和不可预测。这些女性认为疼痛源于身体，是由各种机制引发的，比如繁重单调的工作、环境影响、紧张和忧虑、应得的惩罚或遗传因素。瑞典的这项研究表明，家庭因素对有偿工作中的组织安排和优先事项有很大影响。在这个工人阶级女性样本中，在疼痛和病假的情况下，家庭观念增强而工作抱负下降。与康复相关的问题可以通过更仔细地审视家庭状况来解释，特别是女性与其伴侣之间关于职责分工和权力结构的不成文约定——婚姻契约。几位女性向哈姆贝格和约翰松报告了遭受虐待和暴力的经历，她们中的大多数人认为这是她们疼痛和健康不佳的根源之一。这些女性强调，善解人意的医生会询问暴力情况，领会暗示，确认谈论此事是可以接受的，并避免那些可能轻易增加女性内疚感的询问和指责。
